Perjeta (pertuzumab)

Perjeta, taken in combination with trastuzumab and docetaxel, is a first line treatment for patients with HER2+ metastatic breast cancer. It can extend life by nearly 16 months, compared to the alternative treatment option of trastuzumab and docetaxel alone.

The National Institute of Health and Care Excellence (NICE) began an appraisal of the drug in 2012, but this was never concluded. However, it has been available through the Cancer Drugs Fund in England for nearly four years and has become an established treatment for patients with this type of breast cancer.

As a result of changes to the Cancer Drugs Fund last year, NICE resumed its appraisal and a decision on Perjeta is expected soon. Wales and Northern Ireland normally follow NICE’s decisions so we would expect Perjeta to be made available in those nations as well if it is approved.

Earlier this year, Perjeta was rejected for routine use on the NHS in Scotland by the Scottish Medicines Consortium (SMC).

Ibrance (palbociclib)

Palbociclib is the first of a new class of drugs, selective inhibitors of cyclin-dependent kinase (CDK) 4 and 6. Palbociclib taken with an aromatase inhibitor (a type of hormone therapy) is a first line treatment option for patients with hormone positive, HER2- locally advanced or metastatic breast cancer. Clinical trials suggest that palbociclib with letrozole (an aromatase inhibitor) could provide patients with an average of 10 additional months compared to letrozole alone without their breast cancer progressing.

In February 2017, palbociclib was provisionally rejected for routine use on the NHS in England because it was not considered to be cost-effective. The appraisal process has now been paused to enable the drug’s manufacturer, Pfizer, to submit updated evidence and a final decision is expected later this year. Palbociclib is also going through the appraisal process in Scotland.

Following pressure from Breast Cancer Now and our supporters, Pfizer decided to offer the treatment free of charge for NHS patients across the UK while a final decision is made.

Kisqali (ribociclib)

Ribociclib is also a CDK4/6 inhibitor that is taken with an aromatase inhibitor as a first line treatment option for patients with hormone positive, HER2- locally advanced or metastatic breast cancer. Clinical trials suggest that ribociclib with letrozole could provide patients with an average of just over nine months compared to letrozole without their breast cancer progressing.

A decision is expected later this year. The SMC are due to assess ribociclib for use on the NHS in Scotland early next year.

Faslodex (fulvestrant)

Fulvestrant is a treatment for post-menopausal women with hormone receptor positive, locally advanced or metastatic breast cancer. It can provide women with nearly three months of additional quality time before their breast cancer progresses, compared to the alternative treatment option of an aromatase inhibitor.

It was provisionally rejected as a first line treatment for routine use on the NHS by NICE in September 2017. The drug’s manufacturer, Astra Zeneca, is submitting further evidence and a final decision is expected later this year. The SMC has not yet appraised fulvestrant as a first line treatment.